The present invention relates to a system and method for the biomechanically accurate measurement of posture and for providing a patient with a suitable corrective exercise program. More particularly, the present invention relates to a system and method to automatically analyse the location of anatomical markers placed over skeletal landmarks to obtain biomechanical parameters; a system and method that uses these biomechanical data to automatically detect and/or quantify postural deviations from correct anatomical alignment; a system and method to automatically generate corrective exercise routines. The present invention also relates to the use of the Internet to provide a distributed system for patient care involving image acquisition in a clinical environment, data analysis at a central server and communication between the central server and the health-care professional as well as potential follow-up and feedback between the patient and either the health-care professional or the central server or both.
A tree trunk grows straight up and tree branches are symmetrical around this solid core to provide a xe2x80x9cposturexe2x80x9d to withstand the effects of wind and gravity. We too have an optimal posture that allows us to function most efficiently. As builders and architects use plum lines to arrange the walls and supporting structures of a home, we use plumb lines to define this ideal postural alignment. In correct posture, a plumb line dropped from you ear will go through your shoulder, the middle of your pelvis, the middle of your knee, and the front of your anklebone. Your head, trunk, pelvis and knees are xe2x80x9cstackedxe2x80x9d one on top of the other. Deviations from this positioning can have negative consequences to your health and well being, and correcting postural alignment can make a person look and feel better. Ideal or optimal posture minimizes energy expenditure and muscle work necessary to maintain deviant posture in the face of gravitational forces. As patients become more and more proactive in their choice or health care, they will certainly demand amelioration of their disordered posture. For example, lower back pain has often been attributed to abnormal postural relationships between body segments, and is frequently a cause of patient complaints to family care physicians.
Typically, practitioners are content with a basic appreciation of a client""s posture. Systematic biomechanical analyses are rarely performed because they are time intensive and require specialized equipment. Instead, only qualitative observations are often made. Specialists, such as Chiropractors and physiotherapists are sometimes trained to make postural assessments, often employing qualitative measures to assess posture and determine corrective measures. Practitioners may refer to these specialists, but again, the procedures are time and labor intensive and consequently, are expensive for the patient, who may or may not have insurance to cover these expenses. Further, qualified medical practitioners, such as family practice physicians, may want to perform such analyses but lack the specialized equipment or training to accurately assess posture based on observations alone. Consequently, a cost effective and highly automatic system is needed to assist practitioners in effective assessment and treatment of postural difficulties.
In 1998, Tonix Santxc3xa9 introduced a biomechanical computation system based on the manual identification of anatomical markers from analog video images. Clinicians manually identified the location of these markers on images and some biomechanical computations were performed. However, it took a long time to place markers because common scotch tape first had to be applied to patients and then markers affixed to this adhesive. There was also no automatic detection of marker placement, no automatic detection of postural deviations, and no automatic generation of exercise routines to ameliorate postural deviations. The placement of anatomical markers on the body""s surface was not based on any established model of ideal postural alignment. In other automated processes for postural evaluation, the markers are placed on the patient""s loose-fitting clothes, such a method lacks precision, because first, it is difficult to determine the location of appropriate structural landmarks through loose-fitting clothing, and the position of the markers may move because clothing can move in relationship to the skin surface. Also, markers can not be safely placed on the patient""s skin because they are not compliant with hypoallergenic requirements.
Another deficiency of the actual method to evaluate and correct patient""s posture is the loss of control of the health-care practitioner in the treatment given to his or her patient when he or she refers the patient to a specialist such as chiropractor or physiotherapist. The patient has to take several appointments from several potential specialists. Furthermore, no health-care practitioner or specialist alone can benefit from experience with thousands of patients and be able to correlate biomechanical information from these patients with appropriate treatment and results obtained. There is neither a way to share experience in an efficient way between several health-care practitioners and/or specialists treating this many patients. There is also no way to provide a quantified follow-up of progress.
One aim of the present invention is to provide a process and apparatus to acquire biomechanical position data in selecting marker positions referenced with respect to the patient""s skeletal anatomy by one of skin surface features having minimal variability from one patient to the next and skeletal features palpable from a skin surface of the patient and in attaching a scanable marker on the patient at each of the marker positions, these marker positions being used to calculate the positions of body segments.
Another aim is to provide a method to analyze these body segment positions to obtain body segment biomechanical parameters and deviations.
An other aim of the present invention is to provide a method to use these biomechanical deviation values to determine postural deviations and corrective exercises to rectify these deviations.
Another aim of the present invention is to use the Internet to provide a distributed system for patient care involving image acquisition in a clinical environment, data analysis at a central server and communication between the central server and the health-care professional as well as potential follow-up and feedback between the patient and either the health-care professional or the central server or both.
In accordance with the present invention there is provided a method of acquiring biomechanical position data for use in postural analysis, this method comprising the steps of:
a) selecting a plurality of marker positions referenced with respect to an anatomy of a patient by one of:
skin surface features having minimal variability from one patient to the next; and
skeletal features palpable from a skin surface of the patient;
b) attaching a scanable marker on the patient at each of the marker positions, the step of attaching including palpating the patient to define at least some of the marker positions; instructing the patient to stand relaxed and in normal posture; and
c) scanning the markers on the patient to obtain position data for each of the marker positions.
The method in accordance with a preferred embodiment of the present invention, wherein the patient is scanned from a front, side and rear viewpoints.
The method in accordance with a preferred embodiment of the present invention, wherein the step of scanning comprises photographing the patient against a backdrop, the markers comprising contrasting visual markers, the backdrop including a plurality of scale and orientation reference marker points.
The method in accordance with a preferred embodiment of the present invention, wherein the markers comprise an adhesive layer for sticking to the patient.
The method in accordance with a preferred embodiment of the present invention, wherein the step of photographing comprises using a digital camera with a flash to obtain digital images, the markers comprising retroreflective markers.
The method in accordance with a preferred embodiment of the present invention, wherein some of the markers are scanned from more than one of the viewpoints and comprise retroreflective spheres.
The method in accordance with a preferred embodiment of the present invention, wherein the step of instructing the patient to stand relaxed and in normal posture comprises requesting the patient to walk in place prior to standing still.
The method in accordance with a preferred embodiment of the present invention, wherein the step of scanning comprises automatically recognizing the markers and the reference marker points in the digital images using a computer.
The method in accordance with a preferred embodiment of the present invention, wherein the computer comprises a user interface and, when the computer recognizes too many or too few of the markers, input is accepted via the user interface to remove or add, with reference to the digital images, the position coordinates of the markers which the computer incorrectly recognized or failed to recognize.
In accordance with the present invention, there is provided a method for calculating postural deviation values in a patient comprising the steps of:
a) obtaining position data identifying a position in space of body segments of the patient while standing relaxed and in normal posture, the body segments comprising head-shoulders, shoulders-pelvis, pelvis-hips, hips-knees and knees-ankles;
b) obtaining height and weight data of the patient;
c) calculating vertical and horizontal plumb lines using the position data;
d) calculating for at least some of the body segments an angle of deviation value and distance of deviation value with respect to the plumb lines using the position data.
The method in accordance with a preferred embodiment of the present invention, wherein the angle and distance of deviation values are referenced with respect to average or normal values.
The method in accordance with a preferred embodiment of the present invention, further comprising a step of calculating an effective weight or stress of at least one of the body segments using an estimated weight of the at least one body segment and the deviation values.
The method in accordance with a preferred embodiment of the present invention, wherein the deviation values are calculated for all of the body segments.
In accordance with the present invention there is provided a method of selecting exercises for improving tonicity and correcting posture in a patient, the method comprising the steps of:
a) obtaining biomechanical position data of the patient while standing relaxed and in normal posture, the position data indicative of postural problems requiring correction;
b) ranking the postural deviations by severity and priority;
c) correlating the position data with exercises for strengthing or stetching specific muscles or muscle groups to obtain ranking data for the exercises;
d) compiling an exercise program for the patient based on the ranking data.
The method in accordance with a preferred embodiment of the present invention, wherein the step of compiling comprises manually selecting exercises from a ranked list of exercises.
The method in accordance with a preferred embodiment of the present invention, wherein the exercises are grouped in sets of exercises each attempting to correct a specific postural deviation, the step of correlating comprising correlating the position data with the sets of exercises, and the exercise program comprising a series of the sets of exercises.
The method in accordance with a preferred embodiment of the present invention, wherein the exercises are grouped in sets of exercises each attempting to correct a specific postural deviation, the step of correlating comprising correlating the position data with the sets of exercises, and the exercise program comprising a series of the sets of exercises.
The method in accordance with a preferred embodiment of the present invention, wherein the position data identifies a position in space of body segments of the patient, the body segments comprising head-shoulders, shoulders-pelvis, pelvis-hips, hips-knees and knees-ankles, and the step of correlating comprises:
a) calculating vertical and horizontal plumb lines using the position data;
b) calculating for at least some of the body segments an angle of deviation value and distance of deviation value with respect to the plumb lines using the position data;
c) comparing the deviation values to normal values for the at least some of the body segments to obtain deviation priority values;
d) ranking the deviation priority values according to an order of severity or importance; and
e) determining the ranking data based on an association of the exercises with body segment deviations in accordance with the order of severity or importance.
The method in accordance with a preferred embodiment of the present invention, wherein the step of ranking the deviation priority values according to an order of severity or importance comprises manually selecting deviations to be corrected by the exercise program, the order of severity or importance reflecting those deviations manually selected.
The method in accordance with a preferred embodiment of the present invention, wherein the exercises are grouped in sets of exercises each attempting to correct a specific postural deviation, and the exercise program comprising a series of the sets of exercises.
The method in accordance with a preferred embodiment of the present invention, wherein the exercise program is limited to a maximum number of exercises, the step of manually selecting deviations is automatically restricted when a maximum number of exercises corresponding to the selected deviations exceeds the maximum number for the exercise program.
The method in accordance with a preferred embodiment of the present invention, wherein the step of compiling comprises repeating ones of the exercises corresponding to most severe postural problems regularly throughout the exercise program and including ones of the exercises corresponding to less severe postural problems for only part of the program.
The method in accordance with a preferred embodiment of the present invention, wherein the step of compiling comprises including ones of the exercises corresponding to moderately severe postural problems more intensively for only part of the exercise program.
The method in accordance with a preferred embodiment of the present invention, wherein the step of compiling comprises repeating ones of the exercises corresponding to most severe postural problems regularly throughout the exercise program and including ones of the exercises corresponding to less severe postural problems for only part of the program.
The method in accordance with a preferred embodiment of the present invention, wherein the step of compiling comprises including ones of the exercises corresponding to moderately severe postural problems more intensively for only part of the exercise program.
The method in accordance with a preferred embodiment of the present invention, further comprising steps of:
a) obtaining, after completing of the exercise program, new biomechanical position data of the patient while standing relaxed and in normal posture;
b) evaluating an effectiveness of the exercises in the exercise program for correcting the postural problems; and
c) adjusting parameters used in the step of correlating for future patients based on the effectiveness evaluated in the previous step.
The method in accordance with a preferred embodiment of the present invention, wherein the exercise program is repeatedly varied until the effectiveness of the exercises is optimized.
The method in accordance with a preferred embodiment of the present invention, wherein the steps of correlating, evaluating and adjusting are carried out using a centralized shared database of the parameters used in the step of correlating for a large number of patients.
The method in accordance with a preferred embodiment of the present invention, wherein the parameters include at least one of age and an activity level of the patient.
In accordance with the present invention there is provided a method of providing posture health care using a distributed system, the method comprising the steps of:
a) obtaining personal data of a patient, the personal data including weight, height, gender and activity data of the patient, and obtaining posture anatomical reference position data of the patient at a biomechanical measurement station;
b) processing the personal and position data using data stored in a remote central database to obtain preliminary postural deviation assessment data;
c) providing the preliminary postural deviation assessment data to one of a health-care practitioner and the patient;
d) obtaining corrected postural deviation assessment data from one of the health-care practitioner and the patient; and
e) modifying the data stored in the central database using the corrected data.
The method in accordance with a preferred embodiment of the present invention, wherein the preliminary postural deviation assessment data comprises a ranked list of deviations and a preliminary selection of the deviations to be included in a therapeutic exercise program, and the corrected data comprises a corrected selection of the deviations to be included in a therapeutic exercise program.
The method in accordance with a preferred embodiment of the present invention, wherein:
the preliminary postural deviation assessment data comprises a set of therapeutic exercises of an exercise program;
the corrected data comprises new posture anatomical reference position data of the patient obtained after completion of the exercise program; and
step (e) comprises processing the new reference position data to determine an effectiveness of the therapeutic exercises in correcting postural deviations and modifying accordingly the data stored in the central database.
The method in accordance with a preferred embodiment of the present invention, wherein:
step (a) comprises validating completeness of the reference position data at the biomechanical measurement station and transmiting the personal and position data to a central server;
step (b) is a carried out at the central server;
step (c) comprises transmitting the preliminary postural deviation assessment data from the central server to one of the health-care practitioner and the patient;
step (d) comprises transmitting the corrected data to the central server; and
step (e) is carried out by the central server.
The method in accordance with a preferred embodiment of the present invention, wherein the biomechanical measurement station includes a health-care practitioner client station in communication with the central server.
The method in accordance with a preferred embodiment of the present invention, wherein the client station uses a web browser interface to communicate with the central server, the central server providing a secure connection to a biomechanical assessment report web document for the patient.
For the purpose of the present invention the following terms are defined below.
The term xe2x80x9canterior viewxe2x80x9d is intended to mean the view of the front of the body (with the person in anatomical position). The term xe2x80x9clateral viewxe2x80x9d is intended to mean the view of the patient from the side.
The term xe2x80x9cposterior viewxe2x80x9d is intended to mean the view of the patient from behind.
The term xe2x80x9cbody segment parametersxe2x80x9d is intended to mean the spatial coordinates of body segments and key anatomical landmarks taken from the images from the lateral, anterior and posterior views.
The present invention provides a process and apparatus to acquire patient images rapidly and accurately in a clinical environment, to extract body segment parameters from surface markers, a method for analysing these data to obtain biomechanical parameters and deviations, a method involving the use of these biomechanical parameters and deviations for the detection of postural deviations and the selection of corrective exercices, and the use of Internet to provide a distributed system for patient care involving image acquisition in a clinical environment, data analysis at a central server and communication between the central server and the health-care professional as well as potential follow-up and feedback between the patient and either the health-care professional or the central server or both. The placement of markers based on a well established model of ideal postural alignment is crucial because the placement of markers determines the relative deviation of body segments from vertical and horizontal xe2x80x9cplumbxe2x80x9d or ideal alignment. The current system uses the most widely used and respected anatomical definition of ideal postural alignment (Kendall, McCreary, and Provance, 1993). And, a sophisticated marker placement system has been designed to place surface markers on locations defining this alignment. The importance of a correct definition of ideal posture is obvious when one is attempting to detect postural deviations. A further crucial difference between the earlier systems and the present invention is the use of scanning technology to automatically detect the location of reflective markers placed on the skin overlying skeletal landmarks. They can be placed directly on the skin because they are made from a hypoallergenic material. Such marker placement is highly important, because it avoids the potential examiner error associated with the manual identification of presumed skeletal landmarks from video images. The current system automatically detects markers, and their locations are transmitted automatically through the web for the calculation of postural deviations. Further differences between earlier state of the art and the current system includes the automatic generation of a personalized exercise plan based on individualized and automatic assessments of patients"" biomechanical and postural status.
As such, the biomechanical knowledge system radically changes the practice of biomechanical analysis by creating an objective and effective methodology that is simple to implement using complex yet innovative technology. We have developed a strong theoretical model of biomechanical function as well as innovative methods for data capture, analysis and adapted exercise routines. Both theoretical and technological aspects of our system have been integrated into a coherent and operational system.
We have successfully linked a biomechanical assessment of potential postural deviations to the underlying muscular components giving rise to these deviations. We go further by suggesting specific muscular training routines to ameliorate the underlying muscular and postural deviations. This unique theoretical and methodological link will be outlined in more detail below.